Provider Demographics
NPI:1346432101
Name:MACNIVEN, ROSEMARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:MACNIVEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W WOODS RD
Mailing Address - Street 2:UNIT 29
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1774
Mailing Address - Country:US
Mailing Address - Phone:203-589-6107
Mailing Address - Fax:203-248-5623
Practice Address - Street 1:3074 WHITNEY AVE
Practice Address - Street 2:BUILDING #2 - SECOND FLOOR
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:203-589-6107
Practice Address - Fax:203-248-5623
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140002847CT01OtherBC/BS